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经导管主动脉瓣置换术后永久性起搏器植入的风险:哪些因素最为相关?

Risk of permanent pacemaker implantation following transcatheter aortic valve replacement: Which factors are most relevant?

作者信息

Batta Akash, Hatwal Juniali

机构信息

Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India.

Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India.

出版信息

World J Cardiol. 2024 Feb 26;16(2):49-53. doi: 10.4330/wjc.v16.i2.49.

Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve replacement. The encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk patients. However, this is not without challenges. Need for permanent pacemaker (PPM) post-TAVR remains the most frequent and clinically relevant challenge. Naturally, identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is important. Various demographic factors, electrocardiographic features, anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following TAVR. Amongst these electrophysiological variables, most notably a prolonged QRS > 120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression models. The index study by Nwaedozie highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS > 120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.

摘要

经导管主动脉瓣置换术(TAVR)已成为重度有症状主动脉瓣狭窄患者在外科主动脉瓣置换术之前的一种强有力的治疗选择。大型随机对照试验的令人鼓舞的结果导致TAVR的使用呈指数级增长,甚至在低风险患者中也是如此。然而,这并非没有挑战。TAVR术后对永久性起搏器(PPM)的需求仍然是最常见且与临床相关的挑战。自然地,识别使个体易在TAVR术后发生高度传导阻滞的危险因素很重要。各种人口统计学因素、心电图特征、解剖学因素和手术特征都与TAVR术后高级别传导阻滞的发生以及对PPM的需求有关。在这些电生理变量中,最值得注意的是,无论传导阻滞类型如何,QRS时限延长>120 ms似乎是逻辑回归模型中最强的预测因素之一。Nwaedozie的索引研究强调,TAVR术后需要PPM的患者基线QRS>120 ms的几率更高,并且比那些不需要PPM的患者更有可能患有糖尿病。

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